It is important always to keep in mind that medical abnormalities can present as anxiety disorders. This principle proves critical to establishing the correct diagnosis. Much as a patient with physical symptoms may feel his problem is not psychiatric, so, too, can a patient with anxiety and worry not feel that her problems could be medical. The most classic example of this would be a woman who presents with new onset anxiety but has an overactive thyroid. It could also be a man who cannot explain his new onset panic attacks but neglects to mention his recent experimentation with cocaine. Another example would be a man who did not put together his heightened anxiety in crowds and while taking tests with his prior accident, when he went through the windshield of the car and sustained a concussion.
A woman who cannot pinpoint the onset of her irritability to the starting of birth control pills or the onset of menopause is another example. This could also occur in the case of an elderly gentleman who becomes anxious about not being able to concentrate on his job but neglects to tell his doctor about his history of promiscuity and turns out to have untreated syphilis. Epilepsy, new-onset cancers, or HIV can have their first manifestations be psychiatric in nature. Always keeping a watchful eye on what might be a psychiatric manifestation of a medical problem can prove invaluable in the long run and allow a therapist to direct the patient in the right direction.
We cannot separate the brain and its health from the body and its conditions. Therefore, it does not surprise us that women who drink while they are pregnant predispose their infants to a wide range of developmental, learning, and/or psychiatric vulnerability. This principle also means that even if your mental health care provider is a physician, you would do well to check in with your primary care provider.
While I don’t doubt that a medical illness can have a “psychiatric manifestation,” I’m also aware that many of us who have a diagnosis of mental illness are wary and even angered when we feel that our physical symptoms are too easily discounted as being “all in our heads.” The concern is that when a medical chart indicates that an individual has had a psychiatric history, including hospitalizations, a genuine physical complaint may be seen as a reflection of that history.
Healthwise, this can be just as dangerous as over-looking the possible psychiatric component. This is not just theoretical! As a peer advocate—a person with a diagnosis of mental illness working with others in the mental health system—I’ve heard a number of com-plaints about just such a thing happening, with the result being a delay in those individuals’ receiving the proper medical attention, or actually finding themselves on a psychiatric unit when their acute symptoms were actually medical. It is a definite issue, and it’s why many men and women who pursue help for a mental or emotional disorder are concerned about being labeled because of their illness. Labeling—it’s fine for Campbell’s Cream of Mushroom soup, but not for us.